Non Insulin Drugs for DM2 Flashcards
Drug Classes
Sensitizers: Metformin, Glitazones
Secretagogues: Sulfonylureas, Meglitinides
Other
Metformin
S/E
Other Uses
Added Points (4)
First Line for Drugs (after diet/exercise)
S/E: diarrhea (increase slowly to avoid) Other Uses: PCOS Added Points: - Reduces CV mortality - Safe in HF and mod renal impairment - Inexpensive - Hypoglycemia rarely occurs when monotherapy
Glitazones
Drugs Added Points (4)
-glitazones (rosiglitazone, pioglitazone)
Added Points:
- Reduces BC efficacy
- Rosiglitazone increases LDL
- Do no use with HF
- CAN be used with metformin
Sulfonylureas
Potency / Generation
Drugs
Positives (3)
Patient Selection (4)
- Second Generation More Widely Used*
- This is bc they are more potent than 1st generation and therefore have a longer duration of action
- Start at lowest dose and titrate up
Glipizide, Glyburide, Glimeperide
Positives about the drug
- Less Frequent Administration
- Fewer A/E
- Fewer Drug Interactions
- Duration more than 5 years
- No hx of insulin therapy
- Close to normal body weight
- FPG < 180
Sulfonylureas Adverse Effects (4)
- Hyperinsulinemia + Hypoglycemia
- happens more in elderly, hepatic dx, renal dx - Weight gain due to increased appetite
- less with glipizide and glimepiride than glyburide - GIT upset: n/v/d
- Photosensitivity
Sulfonylureas Contraindications (4)
- Hepatic Impairment or Renal Insufficiency
- Pregnant or Lactation
* * can cause fetal hypoglycemia @ birth ** - DM1
- Sulfa Allergies (depends)
- idk look this up
Meglitinides
Drugs
Indications (3) + 2
repaglinide and nateglinide
Indications:
- DM2
- Monotherapy or in combo - combo better
- Specific use in pts allergic to sulfur or sulfonylureas
- good for pts that get hypoglycemia with sulfas **
- better for post pradinal control
- take with meals (good for irreg schedule)
Meglitinides A/E (7)
gub-hhaw
- Hypoglycemia
- GIT: d/c
- URI
- Headache
- Arthralgias
- Back/Chest Pain
- Weight Gain
Meglitinides Contraindications (5)
- DM1
- DKA
- Increased alcohol intake (increases risk of hypo)
- Severe infection, surgery, trauma, severe stressors
- Pregnancy/Lactation/Children
Alpha Glucosidase
Drugs
MOA
A/D
Notes (3)
Acarbose + Miglitol
MOA:
- Inhibiting this enzyme slows digestion of carbs
A/E: Flatulence, Bloating, Diarrhea
* don’t give with IBD *
Notes:
- Requires frequent dosing TID
- weight neutral
- Less reduction in A1C
SGLT2
Drugs
Benefits (5)
Negatives (7)
-gliflozin (emp, cana, dapa)
Benefits: - intermediate A1C reduction - Low risk of hypoglycemia - BP lowering effect - CV BENEFIT with ASCVD >>>> ASCVD risk reduction + HF >>>> empagliflozin and canagliflozin - Renal Benefit (emp, cana, dapa) CIL-BR
Negatives:
- UTI/Urinary Frequency
- GU mycotic infection
- Hypotension (depletes volume)
- DKA - atypical presentation
- increased LDL
- Hyperkalema (esp in decrease kid function)
- amp (cana)
MONITOR CBC AND LDL
SGLT2 Contraindications (4)
DM1
DKA
Pregnancy
Severe Kidney Disease
- GFR < 45 (cana, dapa, emp)
- GFR < 60 (ertu)
GLP1
Drugs
Benefits
Negatives
-glutides
Benefits:
-monotherapy decreased risk of hypoglycemia
- decreased PPG values
- (option) combo injection with basal insulin
-CV BENEFITS in those with ASCVD or CKD
(lira, sema)
- Weekly injections (dual, exen ER, lira, sema inj.)
unless given with inj combo of insulin
IMPORTANT:
- dulaglutide DM2 med to reduce CV risk for with and without ASCVD !!!!!!!
Negatives:
- Injection except sema
- A/E: headache, nausea, diarrhea , decrease BC
there’s are more A/E on slide
DPP4 bears
Drugs
Adv (6)
Disadv (3)
-gliptins (sitagliptin, saxagliptin, linagliptin, alogliptin)
Advantages: GRAWWL
- GIT neutral
- renal dosing (sita saxa alo)
- albuminuria reduction
- well tolerated
- weight neutral
- Low risk of hypo in monotherapy
Disadvantages WPC (where polarbears climb)
- CYP3A4 (saxa, lita)
- Pancreatitis/Joint Pain
- Worsens HF
